Provider Demographics
NPI:1104009521
Name:DIANA C TANNEY, MD, PROFESSIONAL, LLC
Entity Type:Organization
Organization Name:DIANA C TANNEY, MD, PROFESSIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-442-2913
Mailing Address - Street 1:4745 ARAPAHOE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1082
Mailing Address - Country:US
Mailing Address - Phone:303-442-2913
Mailing Address - Fax:303-444-6198
Practice Address - Street 1:4745 ARAPAHOE AVE STE 310
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1082
Practice Address - Country:US
Practice Address - Phone:303-442-2913
Practice Address - Fax:303-444-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty